A systematic review and meta-analysis found the most effective front-line immunotherapy for metastatic renal cell carcinoma (mRCC) was pembrolizumab plus axitinib, these findings were published in Annals of Palliative Medicine.

After recent advances in the development of immune checkpoint inhibitor therapies for the treatment of mRCC, it remains unclear which of the newer treatment options may be the most effective. In order to compare the performance of these treatment options, researchers from Sichuan University in China searched publication databases through July of 2020 for studies of immunotherapy for mRCC.

A total of 5 articles comprising 4049 patients were included in this study. All studies compared clinical outcomes with sunitinib. The intervention arms included the therapies of atezolizumab plus bevacizumab, atezolizumab, nivolumab plus ipilimumab, avelumab plus axitinib, or pembrolizumab plus axitinib.

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For progression-free survival, avelumab plus axitinib associated with the best progression-free survival (hazard ratio [HR], 0.69) followed by pembrolizumab plus axitinib (HR, 0.69) and atezolizumab plus bevacizumab (HR, 0.83).

The analysis of overall survival found pembrolizumab plus axitinib (HR, 0.53) and nivolumab plus ipilimumab (HR, 0.63) improved survival.

For the other interventions, no significant improvement was observed for progression-free or overall survival compared with sunitinib.

Fewer instances of grade 3 to 4 adverse events were observed among patients who received atezolizumab (odds ratio [OR], 0.26), followed by nivolumab plus ipilimumab (OR, 0.50), and atezolizumab plus bevacizumab (OR, 0.60).

This analysis was limited as all studies had a high risk for blinding bias.

The study authors concluded that pembrolizumab plus axitinib may be the most effective first-line immunotherapy for mRCC due to its high progression-free and overall survival. However, most patients receiving this combinatorial therapy (325 out of 429) reported a grade 3 to 4 adverse event, so patients should be monitored closely for adverse reactions.


Liu Z, Chen Y, Wei Z, et al. Comparative efficacy and safety of immunotherapy in the first-line treatment of metastatic renal cell carcinoma: a systematic review and network meta-analysis. Ann Palliat Med. 2021;10(3):2805-2814. doi:10.21037/apm-20-1884

This article originally appeared on Oncology Nurse Advisor